Visual aids in ambulatory clinical practice: Experiences, perceptions and needs of patients and healthcare professionals.

This study aims to explore how visual aids (VA) are used in ambulatory medical practice. Our research group (two doctors, one graphic designer and one sociologist) have led a qualitative study based on Focus Groups. A semi-structured guide and examples of VA were used to stimulate discussions. Participants were healthcare professionals (HP) working in ambulatory practice in Geneva and French-speaking outpatients. After inductive thematic analysis, the coding process was analyzed and modified to eventually reach consensus. Six focus groups gathered twenty-one HP and fifteen patients. Our study underlines the variety of purposes of use of VA and the different contexts of use allowing the distinction between "stand-alone" VA used out of consultation by patients alone and "interactive" VA used during a consultation enriched by the interaction between HP and patients. HP described that VA can take the form of useful tools for education and communication during consultation. They have questioned the quality of available VA and complained about restricted access to them. Patients expressed concern about the impact of VA on the interaction with HP. Participants agreed on the beneficial role of VA to supplement verbal explanation and text. Our study emphasizes the need to classify available VA, guarantee their quality, facilitate their access and deliver pertinent instructions for use.

The Effectiveness of Health Education Using Audiovisual on the Santri Smokers' Motivation to Stop Smoking.

BACKGROUND AND OBJECTIVE: Low motivation to quit smoking affects individual smoking behavior. Health education using audiovisual media can increase smokers' motivation to quit smoking. The objective of this study was to determine the effectiveness of health education using audiovisuals on the Santri smokers' motivation to stop smoking. METHODS: This quasi-experimental study was carried out using a pretest-posttest design. The sample in this study included Santri smokers studying at the Traditional Islamic Boarding School in Aceh Besar . This study consisted of 4 groups. Three groups were given intervention (audiovisual health education with different themes) and one group received just health education. Groups were compered in terms of difference in the mean smokers' motivation to quit smoking. The data analysis was done by running paired t-test and one-way ANOVA. RESULTS: The results of statistical tests showed that there was a difference in the mean motivation to quit smoking before and after the intervention in each group (mean ± SD for group 1 to 4 was 11.52 ± 4.76, 15.39 ± 6.06, 22.57 ± 6.23, and 9.84 ± 6.42, respectively). The highest increase in the mean motivation to quit smoking was allocated to group 3 who received audiovisual health education with the theme of risk of developing cancer due to smoking. CONCLUSION: Health education using audiovisuals could increase the motivation of students to quit smoking, especially interventions on the risk of developing cancer due to smoking. Therefore, health workers are suggested to use audiovisuals to implement various intervention in order to change smoking behavior in students.

Next generation of chemistry and biochemistry conference posters: Animation, augmented reality, visitor statistics, and visitors' attention.

Every branch of science needs visitors' attention during the poster presentation session at conferences, symposiums, seminars, etc. In particular, participants in the chemistry and biochemistry conference need more visual tools to explain their research work in detail. Presence of smartphones and the ability of 2D barcodes will allow chemical reactions or processes to be shown in the form of a movie, animation or augmented reality (AR). Therefore, the next generation of posters will be more interested in this view. Here, the ability of 2D barcodes or QR codes to help researchers to catch more attention in their research work was presented during a poster presentation session. In this way, the visitors showed positive attitudes to the applicability of such tools. Also, some information including the number of poster visitors and interesting topics in the conference can be collected easily which is useful for the scientific and organizing committee of conferences. As a result, biochemistry conference posters can be presented in new ways, based on animation images or video, to capture the attention of viewers and deepen their understanding of poster concepts.

Use of audiovisual media to enhance patients' knowledge regarding the oral adverse effects of oncology treatment / Uso de mídia audiovisual para aprimorar o conhecimento dos pacientes sobre os efeitos adversos orais do tratamento oncológico

Objetivo: o presente estudo teve como objetivo avaliar a eficácia de alternativas didáticas, como a mídia audiovisual, na transmissão de informações sobre os efeitos adversos orais do tratamento oncológico em pacientes com câncer. Métodos: pacientes oncológicos foram divididos aleatoriamente em dois grupos: grupo controle (n = 40) e grupo audiovisual (n = 36). O grupo controle recebeu informações verbais sobre os efeitos colaterais orais do tratamento do câncer. Por outro lado, o grupo audiovisual recebeu a mesma informação verbal, juntamente com uma apresentação ilustrativa de mídia audiovisual. Além disso, foram aplicados questionários sobre o assunto antes e após a intervenção da equipe odontológica. Resultados: o presente estudo empregou o teste exato de Fisher para análise estatística, e os resultados mostraram similaridade estatística entre os dois grupos (P > 0,05). Ambas as abordagens educacionais alcançaram o objetivo pretendido. Conclusão: um diálogo bem conduzido pode criar uma compreensão adequada entre pacientes com câncer, melhorando a sua adaptação. Opcionalmente, o uso de técnicas inovadoras, como recursos audiovisuais, pode ser uma alternativa acessível e eficiente, que também pode ser usada na educação desses pacientes. Dessa forma, vídeos educacionais podem ser usados para melhorar a compreensão dos pacientes, a adesão a esquemas terapêuticos e a qualidade de vida, além de contribuir para um melhor prognóstico.(AU)

Objective: the present study aimed to evaluate the efficacy of didactic alternatives, namely the audiovisual media, in conveying information regarding the oral adverse effects of oncology treatment in cancer patients. Methods: cancer patients were randomly divided into two groups: control group (n = 40) and audiovisual group (n = 36). The control group received verbal information regarding the oral side effects of cancer treatment. Conversely, the audiovisual group received the same verbal information, along with an illustrative audiovisual media presentation. Additionally, questionnaires on the subject were administered before and after the intervention by the dental team. Results: the current study employed Fisher's exact test for statistical analysis, and the results showed statistical similarity between the two groups (P > 0.05). Both educational approaches achieved the intended objective. Conclusion: a well-conducted dialogue can create adequate awareness among cancer patients and improve adaptation. Optionally, the use of innovative techniques, such as audiovisual resources, was observed to be an accessible and efficient alternative that can also be used in patient education. Therefore, educational videos can be used to improve patients' understanding, adherence to therapeutic regimens, and quality of life and contribute to a better prognosis.(AU)

Role of Complementary Medicine (Music, Acupuncture, Acupressure, TENS and Audio-Visual Distraction) in Shockwave Lithotripsy (SWL): A Systematic Review From EAU Sections of Urolithiasis (EULIS) and Uro-Technology (ESUT).

We performed a systematic review to look at the role of alternative or complementary medicine such as music, acupressure, acupuncture, transcutaneous electrical nerve stimulation (TENS) and audiovisual distractions to decrease analgesia requirement and alleviate anxiety during SWL. Twenty-three papers(2439 participants) were included: Music (n = 1056.6%), Acupuncture (n = 517.7%), Acupressure (n = 13.8%), TENS (n = 617.2%), and audiovisual distraction (n = 14.6%). Most of the studies showed that complementary therapy, lowered pain, and anxiety with higher patient satisfaction and willingness to undergo the procedure. With its feasibility and convenience, urological guidelines need to endorse it, and more should be done to promote its use in outpatient urological procedures.

The Precision-Bias Distinction for Evaluating Visual Decision Aids for Risk Perception.

Risk communication is critically important, for both patients and providers. However, people struggle to understand risks because there are inherent biases and limitations to reasoning under uncertainty. A common strategy to enhance risk communication is the use of decision aids, such as charts or graphs, that depict the risk visually. A problem with prior research on visual decision aids is that it used a metric of performance that confounds 2 underlying constructs: precision and bias. Precision refers to a person's sensitivity to the information, whereas bias refers to a general tendency to overestimate (or underestimate) the level of risk. A visual aid is effective for communicating risk only if it enhances precision or, once precision is suitably high, reduces bias. This article proposes a methodology for evaluating the effectiveness of visual decision aids. Empirical data further illustrate how the new methodology is a significant advancement over more traditional research designs.

Improving quality of care in less than 1 min: a prospective intervention study on postoperative handovers to the ICU/PACU.

PURPOSE: Standardisation of the postoperative handover process via checklists, trainings or procedural changes has shown to be effective in reducing information loss. The clinical friction of implementing these measures has received little attention. We developed and evaluated a visual aid (VA) and >1 min in situ training intervention to improve the quality of postoperative handovers to the intensive care unit (ICU) and postoperative care unit. MATERIALS AND METHODS: The VA was constructed and implemented via a brief (<1 min) training of anaesthesiologic staff during the operation. Ease of implementation was measured by amount of information transferred, handover duration and handover structure. 50 handovers were audio recorded before intervention and 50 after intervention. External validity was evaluated by blinded assessment of the recordings by experienced anaesthesiologists (n=10) on 10-point scales. RESULTS: The brief intervention resulted in increased information transfer (9.0-14.8 items, t(98)=7.44, p<0.0001, Cohen's d=1.59) and increased handover duration (81.3-192.8 s, t(98)=6.642, p=0.013, Cohen's d=1.33) with no loss in structure (1.60-1.56, t(98)=0.173, p=0.43). Blinded assessment on 10-point scales by experienced anaesthesiologists showed improved overall handover quality from 7.1 to 7.8 (t(98)=1.89, p=0.031, Cohen's d=0.21) and improved completeness of information (t(98)=2.42, p=0.009, Cohen's d=0.28) from 7.3 to 8.3. CONCLUSIONS: An intervention consisting of a simple VA and <1 min instructions significantly increased overall quality and amount of information transferred during ICU/postanaesthetic care unit handovers.

The effect of cognitive aid design on the perceived usability of critical event cognitive aids.

BACKGROUND: Critical events require that clinicians process information and make decisions quickly. To reduce mental workload during such events, cognitive aids have been developed. We have previously observed that designing such aids to facilitate discrete information transfer decreased time to information finding. However, whether clinicians perceive aids designed for discrete information transfer as more usable than step-by-step designs remains unclear. We hypothesized that experimental cognitive aids designed for discrete information transfer would be judged more usable than step-by-step Linear aids. METHODS: Volunteer clinicians were asked to use cognitive aids during low fidelity simulation scenarios. Experimental cognitive aids featuring color-coded, labeled, and consistently located content clusters were compared with aids formatted in a traditional step-by-step fashion. We then performed a quantitative assessment of perceived usability and conducted structured knowledge elicitation interviews. RESULTS: Clinicians rated the two experimental cognitive aids as more usable than the Linear aid. On a 0-100 scale the median (IQR) rating was 25(18,23) for the Linear aid and 89(80,95) and 81(65,90) for the two experimental designs, respectively, with a higher number indicating greater ease of use (P < .01 for each). Narrative responses suggested specific features that improved usability and a thematic analysis identified six major themes driving preference for cognitive aid use. CONCLUSION: During simulated critical events, cognitive aids designed for discrete information transfer were considered more usable than step by step Linear aids. Specific themes governing usability were identified during mixed methods analysis. Further work is needed to optimize cognitive aid use among anesthesia clinicians.

Does Animation Improve Comprehension of Risk Information in Patients with Low Health Literacy? A Randomized Trial.

Introduction. Enhanced visual effects, like animation, have the potential to improve comprehension of probabilistic risk information, particularly for those with lower health literacy. We tested the effect of presentation format on comprehension of colorectal cancer (CRC) screening probabilities to identify optimal risk communication strategies. Methods. Participants from a community foodbank and a cancer prevention center were randomized to 1 of 3 CRC screening risk presentations. The presentations used identical content but varied in format: 1) video with animated pictographs, 2) video with static pictographs, and 3) audiobooklet with static pictographs. Participants completed pre- and postpresentation surveys. The primary outcome was knowledge of probability/risk information regarding CRC screening, calculated as total, verbatim, and gist scores. Results. In total, 187 participants completed the study and were included in this analysis. Median age was 58 years (interquartile range [IQR]: 14 years), most participants were women (63%), and almost half had a high school education or less (46%). Approximately one-quarter had inadequate health literacy (Short Test of Functional Health Literacy in Adults marginal/inadequate: 28%; Brief Health Literacy Screener low: 18%), and about half had low numeracy (Subjective Numeracy Scale low: 54%; Graphical Literacy Measure low: 50%). We found no significant differences in total, verbatim, or gist knowledge across presentation formats (all P > 0.05). Discussion. Use of an animated pictograph to communicate risk does not appear to augment or impede knowledge of risk information. Regardless of health literacy level, difficulty understanding pictographs presenting numerical information persists. There may be a benefit to teaching or priming individuals on how to interpret numerical information presented in pictographs before communicating risk using visual methods. Trial Registry: NCT02151032.

Assessment of Unintentional Duplicate Orders by Emergency Department Clinicians Before and After Implementation of a Visual Aid in the Electronic Health Record Ordering System.

Importance: Electronic health records allow teams of clinicians to simultaneously care for patients, but an unintended consequence is the potential for duplicate orders of tests and medications. Objective: To determine whether a simple visual aid is associated with a reduction in duplicate ordering of tests and medications. Design, Setting, and Participants: This cohort study used an interrupted time series model to analyze 184 694 consecutive patients who visited the emergency department (ED) of an academic hospital with 55 000 ED visits annually. Patient visits occurred 1 year before and after each intervention, as follows: for laboratory orders, from August 13, 2012, to August 13, 2014; for medication orders, from February 3, 2013, to February 3, 2015; and for radiology orders, from December 12, 2013, to December 12, 2015. Data were analyzed from April to September 2019. Exposure: If an order had previously been placed during the ED visit, a red highlight appeared around the checkbox of that order in the computerized provider order entry system. Main Outcomes and Measures: Number of unintentional duplicate laboratory, medication, and radiology orders. Results: A total of 184 694 patients (mean [SD] age, 51.6 [20.8] years; age range, 0-113.0 years; 99 735 [54.0%] women) who visited the ED were analyzed over the 3 overlapping study periods. After deployment of a noninterruptive nudge in electronic health records, there was an associated 49% decrease in the rate of unintentional duplicate orders for laboratory tests (incidence rate ratio, 0.51; 95% CI, 0.45-0.59), from 4485 to 2731 orders, and an associated 40% decrease in unintentional duplicate orders of radiology tests (incidence rate ratio, 0.60; 95% CI, 0.44-0.82), from 956 to 782 orders. There was not a statistically significant change in unintentional duplicate orders of medications (incidence rate ratio, 1.17; 95% CI, 0.52-2.61), which increased from 225 to 287 orders. The nudge eliminated an estimated 17 936 clicks in our electronic health record. Conclusions and Relevance: In this interrupted time series cohort study, passive visual cues that provided just-in-time decision support were associated with reductions in unintentional duplicate orders for laboratory and radiology tests but not in unintentional duplicate medication orders.

Improving patients' ability to identify their physicians through the use of physician facecards and whiteboards.

Background: Hospitalised patients are often not able to correctly identify members of their physician team. Identifying physicians is a critical component of developing the patient-physician relationship and visual aids have been shown to improve physician identification and overall patient satisfaction. Objectives: The aim of this quality improvement study was to assess the impact of implementation of a physician facecard on the ability of patients to identify their attending physician and other members of the physician team, as well as to evaluate current use of patient whiteboards for physician team identification. Methods: We prospectively studied 149 patients admitted to the medicine teaching service, who were randomised to receive a physician facecard or usual care. Patients were surveyed to determine their ability to identify physician team members. Observational data was also collected regarding use of patient whiteboards. Additionally, all hospitalists were surveyed to assess their perception of these visual aids. Results: Patients who received the facecard were more likely to recall the name of the attending physician as compared with the control group (63% vs 32%, p<0.01). Additionally, 68% of patients with the attending name correctly listed on their whiteboard were able to correctly identify the attending physician (p<0.01). Ninety per cent of patients who both received a facecard and had their whiteboard correctly filled out were able to identify the attending physician. Eighty per cent of hospitalists surveyed agreed that use of the facecard added value and 90% disagreed that routine use of the facecard was burdensome. Conclusion: The use of physician facecards improves the ability of hospitalised patients to identify their attending physicians, and the combined use of facecards and whiteboards may provide additive benefits.

Disparities in Low-Vision Device Use Among Older US Medicare Recipients.

Importance: Low-vision assistive devices are not covered by Medicare and many private insurers, although there is evidence that they can improve functioning and quality of life. Little is known about whether sociodemographic disparities exist in the use of low-vision services by Medicare beneficiaries. Objective: To determine if sociodemographic disparities exist in the use of low-vision services by Medicare beneficiaries. Design, Setting, and Participants: Cross-sectional population-based survey. The National Health Interview Survey is an annually administered nationally representative US survey. Data used in this study were from the 2002, 2008, and 2016 National Health Interview Survey vision supplement. Participants who were Medicare beneficiaries 65 years and older with self-reported vision impairment were included. Main Outcomes and Measures: Multivariable logistic regression was performed to evaluate if sociodemographic or economic factors were associated with self-reported use of low-vision devices or low-vision rehabilitation among Medicare beneficiaries 65 years and older who self-reported vision impairment. Results: There were 3058 participants included in the study. The survey weighted proportion of participants who were men was 37.9% (95% CI, 35.8%-40.0%), while 79.1% (95% CI, 77.2%-80.9%) were non-Hispanic white, 10.2% (95% CI, 9.0%-11.5%) were non-Hispanic black, 6.7% (95% CI, 5.6%-8.1%) were Hispanic, and 4.0% (95% CI, 3.2%-5.0%) identified with another race/ethnicity. The weighted proportion who reported using low-vison devices and low-vision rehabilitation were 26.1% (95% CI, 24.2%-28.1%) and 3.5% (95% CI, 2.8%-4.3%), respectively. In a model adjusted for ocular diagnoses, Hispanic individuals (odds ratio, 0.61; 95% CI, 0.39-0.97) and individuals from other races/ethnicities (odds ratio, 0.39; 95% CI, 0.19-0.80), but not black individuals, were significantly less likely to report using low-vision devices than white individuals. In the model that was not adjusted for ocular diagnoses, black individuals (odds ratio, 0.73; 95% CI, 0.54-0.99) were also significantly less likely to report using low-vision devices. There were no significant racial/ethnic disparities for reported use of low-vision rehabilitation. Conclusions and Relevance: Additional research is needed to clarify the association between sociodemographics and use of low-vision services in the Medicare population. However, policy makers could consider expanding Medicare coverage to include low-vision devices in an effort to address significant disparities in the use of this evidence-based intervention.

Produção de vídeos educativos sobre saúde a partir da interlocução entre estudantes e pesquisadores / Production of educational videos about health based on the interlocution between students and researchers / Producción de vídeos educativos acerca de la salud basada en la interlocución entre estudiantes e investigadores

A escola como um espaço de saber ­ social, dialógico e cultural ­ é de fundamental importância no processo de popularização dos conhecimentos científicos. Com base em um projeto que se encontra em desenvolvimento, em uma parceria entre a Fiocruz Minas e três escolas da rede pública estadual no município de Belo Horizonte, este artigo relata a interlocução entre escola e pesquisa/ciência. Como estratégia de pesquisa buscou-se envolver ativamente os educandos na construção de questões relacionadas a temas de saúde. Nesse processo de articulação entre escola e instituição de pesquisa, dúvidas e questionamentos distintos levantados em cada uma das escolas foram apresentados aos pesquisadores da Fiocruz, que dialogaram com os discentes. Toda a pesquisa foi registrada na forma de vídeos, visando à construção de um material midiático educativo, que será distribuído na rede pública de ensino do estado de Minas Gerais.(AU)

The school as a social, dialogical and cultural space of learning plays a crucial role in the popularization of scientific knowledge. In the context of a research partnership between Fiocruz Minas and three state schools in Belo Horizonte, this paper describes the experience of a dialogue process between school and research/science. The project's strategy focused on actively involving students in the development of questions related to health issues. As a result of this articulation process different doubts and arguments were raised in each one of the schools and presented to researchers from Fiocruz and all the research participants talked about them. This whole process was filmed and recorded on tapes in order to produce educative media materials that will be distributed to public schools of the state of Minas Gerais.

La escuela, como un espacio de saber ­ social, dialógico y cultural ­, desempeña un papel importante en el proceso de popularización de los conocimientos científicos. Con base en un proyecto en desarrollo en una asociación entre Fiocruz-MG y tres escuelas de la rede pública estadual del municipio de Belo Horizonte, este artículo relata la interlocución entre escuela e investigación/ciencia. Como estrategia de investigación se ha buscado involucrar activamente los alumnos en la construcción de cuestiones relacionadas a temas de salud. En ese proceso de articulación entre la escuela y la institución de investigación, las dudas y los cuestionamientos han sido identificados en cada escuela y han sido presentados a los investigadores de la Fiocruz, que dialogaron con los discentes. Toda la investigación ha sido registrada en vídeos con el objetivo de construir un material mediático educativo, que va a ser distribuido en la rede pública de enseñanza del estado de Minas Gerais.

Teaching Cancer Patients the Value of Correct Positioning During Radiotherapy Using Visual Aids and Practical Exercises.

The aim of this study was to investigate if teaching patients about positioning before radiotherapy treatment would (a) reduce the residual rotational set-up errors, (b) reduce the number of repositionings and (c) improve patients' sense of control by increasing self-efficacy and reducing distress. Patients were randomized to either standard care (control group) or standard care and a teaching session combining visual aids and practical exercises (intervention group). Daily images from the treatment sessions were evaluated off-line. Both groups filled in a questionnaire before and at the end of the treatment course on various aspects of cooperation with the staff regarding positioning. Comparisons of residual rotational set-up errors showed an improvement in the intervention group compared to the control group. No significant differences were found in number of repositionings, self-efficacy or distress. Results show that it is possible to teach patients about positioning and thereby improve precision in positioning. Teaching patients about positioning did not seem to affect self-efficacy or distress scores at baseline and at the end of the treatment course.

The development and evaluation of mini-GEMs - short, focused, online e-learning videos in geriatric medicine.

Mini Geriatric E-Learning Modules (Mini-GEMs) are short, focused, e-learning videos on geriatric medicine topics, hosted on YouTube, which are targeted at junior doctors working with older people. This study aimed to explore how these resources are accessed and used. The authors analyzed the viewing data from 22 videos published over the first 18 months of the Mini-GEM project. We conducted a focus group of U.K. junior doctors considering their experiences with Mini-GEMS. The Mini-GEMs were viewed 10,291 times over 18 months, equating to 38,435 minutes of total viewing time. The average viewing time for each video was 3.85 minutes. Learners valued the brevity and focused nature of the Mini-GEMs and reported that they watched them in a variety of settings to supplement clinical experiences and consolidate learning. Watching the videos led to an increase in self-reported confidence in managing older patients. Mini-GEMs can effectively disseminate clinical teaching material to a wide audience. The videos are valued by junior doctors due to their accessibility and ease of use.

Impact of a visual aid on discordance between physicians and family members about prognosis of critically ill patients.

OBJECTIVE: This study aimed to evaluate the impact of a visual aid on the discordance about prognosis between physicians and family members. METHODS: The study was performed in a general intensive care department with two 6-bed units. In the unit A, family members could consult a visual aid depicting day by day the evolution of global, hemodynamic, respiratory, renal and neurological conditions of the patient on a 10-point scale. In the unit B, they only received oral medical information. On day 7 of the ICU stay, the physician and family members estimated the prognosis of the patient among four proposals (life threatened; steady state but may worsen; steady state, should heal; will heal). Then we compared the rate of discordance about prognosis between physicians and family members in the two units. RESULTS: Seventy-nine consecutive patients admitted in the intensive care department and still present at day 7, their family members and physicians, were enrolled. Patients in the two units were comparable in age, sex ratio, reason for admission, SAPS II at admission and SOFA score at day 7. In the unit A, physician-family members discordance about prognosis occurred for 12 out of 39 patients (31%) vs. 22 out of 40 patients (55%) in the unit B (P=0.04). CONCLUSION: In our study, adding a visual aid depicting the evolution of the condition of critically ill patients day by day to classic oral information allowed the family to have an estimate of the prognosis less discordant with the estimate of the physician.